I'm all for preventative health care. Too bad it's so hard to get people to actually take care of themselves. I wonder how many health care dollars we would save if people stopped stuffing themselves with cheeseburgers and smoking cigarettes?

Maybe I'm just a naive pre-med...
</rant> Carry on.

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Thats exactly why a single payer system wont work... or at the very least would bankrupt the country. With our obesity epidemic and very unhealthy lifestyles combined with the fact that once its free people will start to abuse the system, the only way to pay for this system would be to have a significant portions or people incomes taxed. We're already spending trillions of tax $$ to fix the economy (or pay CEOs bonuses), where are we gonna get the money to cover everyone?

Preventative care isnt the end all be all, telling your 5'3 190lbs patient "your fat, eat more salad, exercise" isnt gonna do anything. We need lifestyle changes which is much much harder to achieve.

If a single payor system was to be implemented doctors and the elderly would get screwed (somebody always gets screwed no matter what system).

However, in countrys with a single payer system the costs of education are either free or heavily subsized. You can add these costs to the amount it would cost for single payer healthcare.

Because as reimbursements drop, the competition lowers leading to high achievers move on to more lucrative endeavours and this results in a drop in quality and depending on how far the drop is and the lag between subsizing medical education, an even greater shortage of doctors.

So we shouldn't ensure all of our citizens receive adequate healthcare because they're already unhealthy.

Right. Think about that for a second and get back to me.

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Everybody agrees that all citizens deserve access to reasonable healthcare. A lot of people just don't want the government to be the main source of payment.
I also believe this country also needs a stronger emphasis on personal responsbility, something the president himself emphasized on the campaign trail occasionally.

Well our current employer-based model is an utter tragedy, as is the entire for-profit model really. I have no idea why people think it's a good idea that a CEO of BC/BS of whatever state gets $20 million a year. The insurance companies make the most money when they deny claims and raise premiums. This is not complicated.

The amount of overhead and the amount of administration that is required to navigate our healthcare system is terrible, anyone who thinks that a government backed national plan would somehow make this problem worse are mistaken and are just buying into the tired GOP talking point of "government is always bad no matter what and has never done anything good!"

Well our current employer-based model is an utter tragedy, as is the entire for-profit model really.

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I agree that the employer based model needs-a-fixin. I've said that on this thread before. There is nothing immoral with people being motivated to make a profit. It has had quite an impact on the history of our country.

The insurance companies make the most money when they deny claims and raise premiums. This is not complicated

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No, it's more complicated. I would agree there is a need for more transparency and more fairness for what is covered and what's not. To say that insurance companies only mode of profits is by denying claims is a falsely broad indictment. Insurance companies generally make money by assuming risk for a lot of people, and then paying for catastrophic events that happen to a few.

The amount of overhead and the amount of administration that is required to navigate our healthcare system is terrible, anyone who thinks that a government backed national plan would somehow make this problem worse are mistaken and are just buying into the tired GOP talking point of "government is always bad no matter what and has never done anything good!"

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This decrease in overhead and administration would not be without its own downsides. You have to pick your poison. Our system is not perfect, but neither is social security, medicare, tricare, the DMV, the Postal Service, etc. There are physicians who work for the VA and in the military serving strictly TriCare covered individuals. Ask them what some of the difficulties are in federally controlled heathcare systems.

There is also the liberal talking point: "The private sector is evil. The government should come in and make this better!" It is also tired and old.

Well when it comes to delivering adequate care to people in this country, one talking point is driven by greed while one is not. We've seen recently how greed works out haven't we? Not to mention that healthcare delivery is not selling iPods, maximizing profit does not necessarily mean best care, in fact I would argue that it almost has to mean inadequate care in our current system. You point to a number of government programs but can you tell me why they're inefficient or bad beyond just throwing them out there? Oh right, government is evil no matter what, I forgot.

Of course there are downsides to every healthcare delivery system, but I'd like to remove greedy profit-driven individuals from running the show, thanks.

My biggest problem is that insurance companies have no problem insuring the healthiest individuals, but the second you're too poor, malnourished, illness stricken, unemployed, chronically ill, old or disabled, they kick you into Medicaid and Medicare. They have absolutely no problem extracting the maximum amount of profit right up until it isn't profitable, then they kick it to the taxpayers to pick up the slack. This is no free market, and your free market logic does not and will never apply to healthcare. (or any other system for that matter, but let's not go there.)

I'll wait to hear back regarding the government programs you mentioned and why they're inefficient or poorly run.

Well when it comes to delivering adequate care to people in this country, one talking point is driven by greed while one is not. We've seen recently how greed works out haven't we? Not to mention that healthcare delivery is not selling iPods, maximizing profit does not necessarily mean best care, in fact I would argue that it almost has to mean inadequate care in our current system. You point to a number of government programs but can you tell me why they're inefficient or bad beyond just throwing them out there? Oh right, government is evil no matter what, I forgot.

Of course there are downsides to every healthcare delivery system, but I'd like to remove greedy profit-driven individuals from running the show, thanks.

My biggest problem is that insurance companies have no problem insuring the healthiest individuals, but the second you're too poor, malnourished, illness stricken, unemployed, chronically ill, old or disabled, they kick you into Medicaid and Medicare. They have absolutely no problem extracting the maximum amount of profit right up until it isn't profitable, then they kick it to the taxpayers to pick up the slack. This is no free market, and your free market logic does not and will never apply to healthcare. (or any other system for that matter, but let's not go there.)

I'll wait to hear back regarding the government programs you mentioned and why they're inefficient or poorly run.

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Please, you dont think politicians are greedy? They're all lawyers and business men. It doesnt matter whose in charge, the government or insurance companies, they are all gonna look to cut costs. Your right greed and profits have no place in healtcare. But the world we live in is dictated by money. Just because things arent right doesnt mean they get fixed. So maybe get off ur high horse and think about things in the context of the real world.

I agree free market economics will never properly apply to healthcare, at least not in a civilized society. Government is inefficient because it has no reason to be efficient. Theres so much bureaucratic garbage that goes into every process. With good reason too, all these politicians wouldnt get as much money if they didnt have to debate every single little things. It took FEMA 5 days to get water to the super dome in an emergency.

The government way of dealing with problems is to form a committee, raise taxes and then throw that money at the problem. Works in the short term but ends up costing the country alot of money.

Everybody looks out for their own include government lackeys. I dont think this is evil and I dont think the government is evil. Its human nature.

How do you propose we afford this single payer system? Theres 50 million people who arent covered currently who will want a piece of the pie. 25 million who are underinsured. Then you have people who are already covered elsewhere who will avoid paying their deductible if they can. People will abuse the system and it will end up costing an absorbitant amount.

Considering that we are 1 trillion dollars in debt and spending a trillion dollars to fix the economy. The US cant afford it. Nor should they since this would not fix the uderlying problem. Whats so different from 10 -15 years ago when we didnt have these problems. Peopl are living more unhealthy lifestyles, giving them insurance doesnt fix this problem it just adds to it.

The amount of overhead and the amount of administration that is required to navigate our healthcare system is terrible, anyone who thinks that a government backed national plan would somehow make this problem worse are mistaken and are just buying into the tired GOP talking point of "government is always bad no matter what and has never done anything good!"

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Bureaucracy and government essentially are synonyms. Much of the administrative costs in medicine are because of the need for thorough documentation, the plethora of insurance companies and the complexities of scheduling. The govt plans notoriously have the most paper work and the most to do. They also reimburse the worst.

Having seen how the VA operates first hand, I assure you, government run heathcare would be an absolute disaster. Ironically H Cliniton actually talked about the merits of the VA system in some of her speeches. All I could think was, "wow it is clear this lady, who is such an expert on heath care, knows next to nothing about heath care"

Well when it comes to delivering adequate care to people in this country, one talking point is driven by greed while one is not. We've seen recently how greed works out haven't we? Not to mention that healthcare delivery is not selling iPods, maximizing profit does not necessarily mean best care, in fact I would argue that it almost has to mean inadequate care in our current system. You point to a number of government programs but can you tell me why they're inefficient or bad beyond just throwing them out there? Oh right, government is evil no matter what, I forgot.

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This is not about greed but rather about taxing an already taxed system. The sheer shock to the system by adding another 50 million people would basically grind our system to a standstill. Perhaps if we slowly increased the amt who had access this may work but that involves such a drastic increase in everything healthcare related that it would take decades to accomplish. The number of hospital beds, supplies, nurses would all need to be drastically increased to meet the demand. The number of physicians would also need to be increased. Since the residency slot numbers are pegged by congress that would take an act of congress to change.

The money involved would be immense and at a time of downturn this would basically stop the flow of money between hands as taxes would have to be increased. As you probably remember from econ, M of govt spending is not the same as M of consumer spending.

The infrastructure is what needs to change before we can even bridge the issue.

You point to a number of government programs but can you tell me why they're inefficient or bad beyond just throwing them out there? Oh right, government is evil no matter what, I forgot.

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Here's a quick snippet from an article that you'll probably reject as capitalist evil slime:

In essence, the US Postal Service is definitely a low-cost option, as long as your customer is flexible. The one thing they do not do is guarantee delivery...FedEx offers same day delivery up to seventy pounds, door-to-door, 365 day a week, including all holidays. FedEx is a good delivery option for rush orders and they offer specific-time deliveries.

My biggest problem is that insurance companies have no problem insuring the healthiest individuals, but the second you're too poor, malnourished, illness stricken, unemployed, chronically ill, old or disabled, they kick you into Medicaid and Medicare.

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If you would please, please, read my earlier posts in this thread so I don't have to repeat myself: I favor the government subsidizing care for many people currently labeled as 'uninsurable'.

This is no free market, and your free market logic does not and will never apply to healthcare. (or any other system for that matter, but let's not go there.)

I'll wait to hear back regarding the government programs you mentioned and why they're inefficient or poorly run.

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I completely agree that healthcare is not even close to a free market as it stands. Until the pt actually pays all of his or her bills w/o insurance and is completely informed about the options available we cannot have a free market. Really, a free market in healthcare could only exist if every pt was a doctor themselves and could weigh the risks, benefits of each location, provider and test. That is not going to happen

Here's a quick snippet from an article that you'll probably reject as capitalist evil slime:

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Ok...let's say I accept this article. Why do you think showing that FedEx might be better than USPS somehow means private profit-driven corporations are better at running our healthcare system than a government backed public option? You threw out like half a dozen government organizations.

Allow consumers to select which insurance company/plan is best for them and their children.

Have the government underwrite the insurance of "uninsurable" individuals

Decrease third party involvement in routine healthcare, and health prevention.

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right? I understand your desire to keep healthcare "private" and a "free market," but it is a pipe dream. Fortunately, you are not a horrible monster and are just trying to maintain the illusion that healthcare is a free market. I understand this and can empathize, but it is a lost cause. Profit has no place in something as fundamental as healthcare in an advanced Western society.

No one is going to argue that it's cheaper in Canada. That's fine. But cheaper doesn't equate to better. And some of the WHO rankings probably don't matter much to the average American either.

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WHO absolutely should matter, and the fact that a lot of Americans ignore what international organizations say is depressing. Ignore statistics and international observers! Think with your gut and "common sense!"

Free markets don't exist, they are utter fantasy. Please tell me one industry that is a successful free market. Here's a hint: none exists. All you have to do is turn on your tv or head to cnn.com to see this for yourself.

I completely agree that healthcare is not even close to a free market as it stands. Until the pt actually pays all of his or her bills w/o insurance and is completely informed about the options available we cannot have a free market. Really, a free market in healthcare could only exist if every pt was a doctor themselves and could weigh the risks, benefits of each location, provider and test. That is not going to happen

Bureaucracy and government essentially are synonyms. Much of the administrative costs in medicine are because of the need for thorough documentation, the plethora of insurance companies and the complexities of scheduling. The govt plans notoriously have the most paper work and the most to do. They also reimburse the worst.

"The recent Medicare bill means a huge increase in administrative waste and a big payoff for the AARP," said study author Dr. David Himmelstein, an associate professor of medicine at Harvard and former staff physician at Public Citizens Health Research Group. "At present, Medicares overhead is less than 4 percent. But all of the new Medicare money  $400 billion  will flow through private insurance plans whose overhead averages 12 percent. So insurance companies will gain $36 billion from this bill. And the AARP stands to make billions from the 4 percent cut it receives from the policies sold to its members."

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You can argue about reimbursement decreases, because I think everyone knows that single-payer would lower reimbursement numbers for a lot of surgical and sub-specialty procedures, but you cannot argue that private insurers are more efficient than Medicare. They have three times the overhead administrative costs that Medicare does. And Medicare Advantage, the private version of Medicare, is a horrible rip-off that costs more for seniors and gets them less.

Having seen how the VA operates first hand, I assure you, government run heathcare would be an absolute disaster. Ironically H Cliniton actually talked about the merits of the VA system in some of her speeches. All I could think was, "wow it is clear this lady, who is such an expert on heath care, knows next to nothing about heath care"

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I'm sorry, but many of the problems with the VA were corrected in the past decade (ie patients losing limbs because they get ignored.) Can you cite any study or provide any actual evidence to your claims? I believe what you are saying but I would like to see something for myself. I'll probably do my surgery rotation at the VA so I guess I'll see what you saw soon enough.

This is not about greed but rather about taxing an already taxed system. The sheer shock to the system by adding another 50 million people would basically grind our system to a standstill. Perhaps if we slowly increased the amt who had access this may work but that involves such a drastic increase in everything healthcare related that it would take decades to accomplish. The number of hospital beds, supplies, nurses would all need to be drastically increased to meet the demand. The number of physicians would also need to be increased. Since the residency slot numbers are pegged by congress that would take an act of congress to change.

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Well first of all, Congress desperately needs to increase residency spots since AAMC decided to bump up med school enrollment 20% over the next decade. Secondly, these uninsured people do not live in a bubble. Insuring them would save money, because they wouldn't show up in the ER with a perforated appendix several days after they would have gone in to their PCP if they had had insurance. You cannot argue against providng care for the uninsured because of the "shock to the system," that is inhumane. On top of that, that logic is false since these people get emergency care already that is often 10+ times more expensive than if they had simply seen their PCP for whatever problem they had. This is the trick to making it work that a lot of people miss: we already pay for the healthcare of all these people! It is just exceedingly expensive because we don't account for them and relegate them to midnight ER visits that cost $20,000.

The money involved would be immense and at a time of downturn this would basically stop the flow of money between hands as taxes would have to be increased. As you probably remember from econ, M of govt spending is not the same as M of consumer spending.

The infrastructure is what needs to change before we can even bridge the issue.

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What is M?

Anyway we could pay for a lot of **** if we got out of Iraq and Afghanistan, reversed Bush's retarded tax-cuts for the wealthy, and eliminated the phase-out of SS taxes for income higher than $100k. If you read nothing else in my post please read that, thanks.

Ok...let's say I accept this article. Why do you think showing that FedEx might be better than USPS somehow means private profit-driven corporations are better at running our healthcare system than a government backed public option?

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You originally asked for me to tell you "why they're inefficient or bad beyond just throwing them out there", and I believe I did. My purpose was to provide an example of how competition and demand drive many segments of our economy to outperform their government counterparts.

I understand your desire to keep healthcare "private" and a "free market," but it is a pipe dream. Fortunately, you are not a horrible monster and are just trying to maintain the illusion that healthcare is a free market. I understand this and can empathize, but it is a lost cause. Profit has no place in something as fundamental as healthcare in an advanced Western society.

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I like my ideas, and I bet other people do too atleast in part. I'll keep my pipe dream.

My working definition of profit is this: To be able to provide a good service to another person, in exchange for enough money to keep the bills paid and have a some left over for yourself and your family. What's wrong with that?

If it's wrong because that profit could be used to provide the same service for someone who can't afford it, then where does this idea stop? For example, we could take everyone who works in the healthcare industry, and just cut their salary in half and use that money to provide healthcare for the 16% or so of Americans that are uninsured.

Free markets don't exist, they are utter fantasy. Please tell me one industry that is a successful free market. Here's a hint: none exists. All you have to do is turn on your tv or head to cnn.com to see this for yourself.

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That's fine if you want to say a true 'free market' doesn't exist anymore. With regard to what Waiter said, other industries may not meet the textbook definition of a free market, but they are definitely more market oriented than healthcare is, and the public seems to work with them without too much trouble. I am pretty autmotively challenged, but I use what information sources I can to make informed decisions on purchases and maintenance and what not. But, I believe healthcare in this country needs to use more market principles than it does right now.

You originally asked for me to tell you "why they're inefficient or bad beyond just throwing them out there", and I believe I did. My purpose was to provide an example of how competition and demand drive many segments of our economy to outperform their government counterparts.

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See my post above to understand how you're wrong with respect to healthcare. Medicare overhead is under 4%, private insurance companies have overhead of 12%+. Three times greater.

My working definition of profit is this: To be able to provide a good service to another person, in exchange for enough money to keep the bills paid and have a some left over for yourself and your family. What's wrong with that?

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Nothing, except your personal definition of profit and what profit actually is are not the same. A corporation's only responsibility is to maximize return on investment for its shareholders. Ergo, private for-profit corporations do whatever they can to increase profits, i.e. dramatically increase overhead, deny claims randomly, obfuscate billing schedules, print erroneous insurance cards, etc.

If it's wrong because that profit could be used to provide the same service for someone who can't afford it, then where does this idea stop? For example, we could take everyone who works in the healthcare industry, and just cut their salary in half and use that money to provide healthcare for the 16% or so of Americans that are uninsured.

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The idea stops at eliminating waste and excess administrative costs that insurance companies have created to maximize their profits. Eliminate the need for profit, get the most out of each dollar.

That's fine if you want to say a true 'free market' doesn't exist anymore. With regard to what Waiter said, other industries may not meet the textbook definition of a free market, but they are definitely more market oriented than healthcare is, and the public seems to work with them without too much trouble. I am pretty autmotively challenged, but I use what information sources I can to make informed decisions on purchases and maintenance and what not. But, I believe healthcare in this country needs to use more market principles than it does right now.

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Look, I'm sorry to say this, but the automotive industry might be one of the worst examples of free markets in the world. Have you heard of GM/Chrysler getting bailed out at all? Ever hear about car companies only issuing recalls for issues that could potentially affect their bottom line? The consumer can never have all the information necessary to make a "rational" decision. This doesn't even take into account the absurdness of rational actors in and of itself.

Anyway I don't really care per se about the auto industry, or the iPod industry, or whatever other capital venture seeking business is going on in this country. I love capitalism. But to pretend that we have free markets is absurd, and applying wrong-headed so called "free market principles" to healthcare delivery is a bad idea.

Actually, yes This is an internet forum, so I can imagine you however I want. I bet you listen atleast once a week to cement your hatred for him and everything he stands for.

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Yes what? I never called you Rush Limbaugh. Go ahead and imagine me however you want, who I am doesn't matter. The words on your screen matter, so why don't we stick to that? (PS I'm not wearing any pants )

Nothing, except your personal definition of profit and what profit actually is are not the same. A corporation's only responsibility is to maximize return on investment for its shareholders. Ergo, private for-profit corporations do whatever they can to increase profits, i.e. dramatically increase overhead, deny claims randomly, obfuscate billing schedules, print erroneous insurance cards, etc.

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Yes companies do that stuff, and it usually gets plenty of media attention when it happens. I agree there needs to be more regulation that absolutely REQUIRES insurance companies to pay claims in certain situations. There needs to be more transparency in the system. That includes having the consumer to have the option of leaving their insurance company w/o having to leave their job; a rarity in our current system. This way, consumers hold insurance companies responsible for their behavior.

The idea stops at eliminating waste and excess administrative costs that insurance companies have created to maximize their profits. Eliminate the need for profit, get the most out of each dollar.

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Is $150,000 for a physician salary 'wasteful'? Could he make less? How about 120...and what about that respiratory therapist...I think he should make less too....Oh oh and private rooms have to go also.....

The consumer can never have all the information necessary to make a "rational" decision. This doesn't even take into account the absurdness of rational actors in and of itself.

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Are you saying that none of us can make rational decisions with our money no matter what products we by? Should the government also mandate what food we eat (they'll know the proper caloric intake and balance of nutrients for my age/BMI), where to live (they'll know where my strengths and skills match up best to the needs of the population), and who to marry (for proper genetic pureness, ofcourse)?

You're right, staying in Iraq is vital to our ability to defend ourselves.

Wait, what? That makes absolutely no sense and is exactly 100% incorrect. Iraq did and continues to weaken us, both militarily and economically. Way to go Bush! Afghanistan is debatable.

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You're the one that suggested we get out of Iraq AND Afghanistan in the same sentence, not me. I don't think you'll find many allies on either side of aisle that don't think we have more work to do in Afghanistan before we starting setting dates to ending combat operations.

Look, this conversation isn't going anywhere. We're just gonna bicker back and forth and probably change no one's opinion in the process. Here's my little manifesto, respond to it and pick it apart as you wish:

Our current system does a decent job of taking care of 85% of our population, but it has some serious problems. My biggest concern is a problem with access: the system leaves too many honest contributing members of society hung out to dry.

I do not believe creating a single system where everyone has equal access to the exact same medical resources provided by our government is the best solution to the access problem. That may make it more affordable in the short term to many uninsured, but it will just spread the access problem out more evenly across the spectrum of society giving everyone a more equal chance of being stuck 'at the end of the line'.

Here are some ideas I am a proponent of:
-Increase the government's role in 2 aspects of our system: First, Create stricter regulations to ensure insurance companies comply with physician requested diagnostics, hospitalizations, etc. This is hairy, but it can be done, and is alot better than the other option. This will decreased administrations costs because there will be less bickering between providers, hopsitals, and insurance companies. Second, have the government underwrite the insurance costs of many of the uninsurables: Cystic Fibrosis, Down Syndrome, etc. Another hairy issue, but these people will require more use of the system at no fault of their own. It doesn't make sense for a profit-seeking company to want their business, UNLESS they know those people's increased risk will not affect their bottom line.

-Decrease third party involvement in the Primary Care setting: Most People should be responsible for their day to day healthcare needs. It makes no sense that you have to have a 3rd party involved when you go get your cholesterol checked, have a sore throat, or need your ADD medication adjusted, etc. The costs of these sorts of visits can be both reasonable to the consumer and provide a good living for providers.

-End the relationship between the employment and health coverage. Patients/Consumers should have the option of selecting what plan is best suited for the health of them and their families, and be able to change their plan at their discretion.

You can't assume it would cost the same amount just because we socialize our system.

We are gonna be adding 50 million people to system, im no mathematician, but that would INCREASE costs.

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Yabut, I calculated this on a "per capita" basis, so the increased costs of adding people to the system are offset by the decreased costs of the system overall. Though I can see how it may cost more to start.

Also doctors are allowed to be doctors and don't have to order expensive tests to defend themselves against lawyers.

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I read recently there's more lawyers in New York City than in all of Japan. That said, people sometimes sue because they need the money to defray the medical costs resulting from a bad outcome (be it the dr's fault or not). So a single-payer system takes away one motivation to sue.

The main point of my post was to show the enormous amount of money that was going to be lost by private health care companies if you got a single-payer system. With that much money at stake, it's any means necessary to discredit such a system.

We are gonna be adding 50 million people to system, im no mathematician, but that would INCREASE costs.

We also have a system where people dont goto the hospital for every little thing because of copays. Once this goes away every little cough and sniffle will require a hospital visit.

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This is where you're wrong and where the majority of people who (monstrously) don't support at the very least UHC, if not single-payer are wrong. The situation now is that people who don't have insurance DON'T go to the doctor until it is an absolute emergency, costing us thousands more. And we still pay for their care, even if they don't. How? By hospitals raising prices and ****ing over cash patients. So we already pay for the uninsured, just with magic voodoo. That's what you're missing here. Insuring everyone would actually lower costs.

* In 2002, the United States spent $5,267 per capita on health care53 percent more than Switzerland, the next-highest-spending country, and 140 percent more than the median OECD country.
* The number of hospital beds per capita in the U.S. was in the bottom quartile of OECD countries in 2002.
* In 2001, the average malpractice payment in the U.S. was $265,103, which was higher than Australia, but 14 percent below Canada and 36 percent below the United Kingdom.

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We also have the lowest infant mortality rate in the western world. Come on guys, we can do better.

Our current system does a decent job of taking care of 85% of our population, but it has some serious problems. My biggest concern is a problem with access: the system leaves too many honest contributing members of society hung out to dry.

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I'm sorry, but this is where you just don't have it right. Our system most certainly does not do a "good job" taking care of 85% of our population. This country sees millions of bankruptcies every year, around half of which are caused by illness or medical expenses. I know you get your 85% figure by subtracting the 15% of the population who don't have insurance, but you are ignoring the tens of millions who are underinsured. In addition, you ignore the fact that the US is ranked 72nd in overall health and healthcare premiums rising as high as 14% per year. You were saying?

I do not believe creating a single system where everyone has equal access to the exact same medical resources provided by our government is the best solution to the access problem. That may make it more affordable in the short term to many uninsured, but it will just spread the access problem out more evenly across the spectrum of society giving everyone a more equal chance of being stuck 'at the end of the line'.

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It would certainly solve the "access" problem, but my instinct tells me that that doesn't concern you since you are one of society's winners. I don't like a caste system, but I guess some people are fine with it as long as they come out on top.

Here are some ideas I am a proponent of:
-Increase the government's role in 2 aspects of our system: First, Create stricter regulations to ensure insurance companies comply with physician requested diagnostics, hospitalizations, etc. This is hairy, but it can be done, and is alot better than the other option. This will decreased administrations costs because there will be less bickering between providers, hopsitals, and insurance companies. Second, have the government underwrite the insurance costs of many of the uninsurables: Cystic Fibrosis, Down Syndrome, etc. Another hairy issue, but these people will require more use of the system at no fault of their own. It doesn't make sense for a profit-seeking company to want their business, UNLESS they know those people's increased risk will not affect their bottom line.

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So in effect you want the government to subsidize a for-profit industry when it isn't profitable. Does that really make sense to you? Aren't you tired of giving taxpayer dollars to greedy corporations who don't give two ****s about this country? (and rightfully so, that's not their job.)

-Decrease third party involvement in the Primary Care setting: Most People should be responsible for their day to day healthcare needs. It makes no sense that you have to have a 3rd party involved when you go get your cholesterol checked, have a sore throat, or need your ADD medication adjusted, etc. The costs of these sorts of visits can be both reasonable to the consumer and provide a good living for providers.

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How much would you charge for a yearly physical with full H&P and labs? Do you think that everyone can afford to swing $200+ whenever they want for no discernible reason? All this would do is stand as a barrier for people to get their yearly check up. Precisely something we should not do if we want to increase preventive care.

Our system most certainly does not do a "good job" taking care of 85% of our population. This country sees millions of bankruptcies every year, around half of which are caused by illness or medical expenses.

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Here's an article about a more recent study, and here are there numbers:
-"According to the American Bankruptcy Institute, 2,039,214 personal bankruptcies were filed in 2005, up nearly five-fold from the 412,510 bankruptcies filed in 1985."
-"The UC Davis study looked at all personal bankruptcy filings in Delaware in 2003, because the state was among the first to make its bankruptcy filings available through the Public Access to Court Electronic Record system and its demographics closely resemble those nationwide...Overall, Zhu concluded that debt accounted for more than 50 percent of recent bankruptcies, while medical problems caused just 5 percent and unemployment led to only 13 percent."

The real picture is probably somewhere in between. Not as bright as I paint it, but not as bleak as yours either.Obviously those numbers will be expected to rise in the current economic climate, but there's a definite disparity between the numbers above and the ones you provided.

In addition, you ignore the fact that the US is ranked 72nd in overall health and healthcare premiums rising as high as 14% per year. You were saying?

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I was saying; I do not ignore those facts. They are not acceptable. However, I don't think our health system is the major problem; our lifestyle is. Here's a paper that talks very briefly about the impact of obesity on our mortality(page 5),in addition to other factors. Additionally, here's an article about another study I'm too tired to find the original source for that reaches a similar conclusion

It would certainly solve the "access" problem, but my instinct tells me that that doesn't concern you since you are one of society's winners. I don't like a caste system, but I guess some people are fine with it as long as they come out on top.

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Hey hey easy...It's a common misconception that all conservatives are Richy-rich types. I was not born with a silver spoon in my mouth. I'm not against change. I talk very passionately about change in our healthcare system. We have to find a balance between effectiveness and efficiency that we can all be satisfied with. But, I just disagree about how to get there. Let's try to keep this a little more civil.

How much would you charge for a yearly physical with full H&P and labs? Do you think that everyone can afford to swing $200+ whenever they want for no discernible reason? All this would do is stand as a barrier for people to get their yearly check up. Precisely something we should not do if we want to increase preventive care.

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$200 might be right for you average primary care practice bowing at the feet of third party payers. Here's a primary care practice in North Carolina that's cut out the middleman. They would charge $45 for thy physical, and $25 for the labwork. The current cut off for qualifying for medicaid in North Carolina for a family of 4 is 31,800/year. Let's say the just missed it by a dollar. Physicals/Labs for 2 adults, and 2 kids would be less than 1% of their annual pre-tax income. That seems fair to me.

This is where you're wrong and where the majority of people who (monstrously) don't support at the very least UHC, if not single-payer are wrong. The situation now is that people who don't have insurance DON'T go to the doctor until it is an absolute emergency, costing us thousands more. And we still pay for their care, even if they don't. How? By hospitals raising prices and ****ing over cash patients. So we already pay for the uninsured, just with magic voodoo. That's what you're missing here. Insuring everyone would actually lower costs.

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We are paying alot more for poor lifestyle choices then real emergencies

We have a ton of fat people and the best way to take care of them is ensuring they have even less access to doctors?! I don't think you've thought this through.

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Ive responded to this before to you. Giving them insurance isnt gonna fix the underlying problem. We need to educate people on how to live healthier lives and people need to take personal responsibility for their own health.

Canada does have pretty low rates of malpractice litigation, but they are more the exception to the rule than we are. That being said, the award amounts in the US are lower than in Canada or the UK.

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The awarded amounts are lower, because companies like to settle. Malpractice money is money that can go directly into helping people instead of lawyers.

Hospitals can shunt that money into helping patients.
Doctors can lower their bills and stop practicing CYA medicine, and they would also have more time to see patients instead of filling out copious amounts of paperwork.

Yabut, I calculated this on a "per capita" basis, so the increased costs of adding people to the system are offset by the decreased costs of the system overall. Though I can see how it may cost more to start.

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I dont think its financially feasible in our country. Most countries started to socialize their medicine when their countries were just starting to become industrialized and when the standard of living was still pretty poor i.e. the UK after the world war.

I read recently there's more lawyers in New York City than in all of Japan. That said, people sometimes sue because they need the money to defray the medical costs resulting from a bad outcome (be it the dr's fault or not). So a single-payer system takes away one motivation to sue.

The main point of my post was to show the enormous amount of money that was going to be lost by private health care companies if you got a single-payer system. With that much money at stake, it's any means necessary to discredit such a system.

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Yea well people complain about the costs but they have no problem driving them up with law suits. I think normally a single payer system would take away motivation for lawsuits, but i have a feeling that tort reform will have a lag period before being taken care of, and I guarentee you people will still try to sue under a single payer system. The implications of this will lead to another doctor shortage.

But I do see your original point, I like the idea of a socialized healthcare but its implementation in this country would be done very poorly and would most likely bankrupt the system.

I'm sorry, but many of the problems with the VA were corrected in the past decade (ie patients losing limbs because they get ignored.) Can you cite any study or provide any actual evidence to your claims? I believe what you are saying but I would like to see something for myself. I'll probably do my surgery rotation at the VA so I guess I'll see what you saw soon enough.

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I think your link and I are saying the exact same thing. Costs come because each insurance company demands something different which adds a significant amt of administrative costs. The gov't still has the most paper work.

When the power of reimbursement is in the hands of the politicians, things get quite messy. Remember just earlier this year when there was going to be a reflexive cut in reimbursement by 10%? Whenever the budget falls short (every year) reimbursements will take a hit. While this may not seem as significant to you now, you will realize that it adversely affects the way that medicine is practiced and pt care suffers.

I think you are trying to challange me on the whole VA thing. Don't. You will almost find that this is a near universal feeling of those in the know. People outside of healthcare always like to point to the VA as some huge achievment and proof that a socialized healthcare system will perform the same as we have it now. Those people have never experienced both the VA and a normal hospital for a long enough time to compare. Things just move much, much slower at the VA. People wait days for tests that they need stat. People with SBO do not have an ex lap for 16 days! You are welcome to look up studies. I dont feel the need to.

We also have the lowest infant mortality rate in the western world. Come on guys, we can do better.

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I think you meant highest.

Regardless, I would be currious to see that infant mortality when controlled for preterm births, drug abuse by mothers, socioeconomic status and other confounders to a infant mortality that much of our population suffers from. On Labor and delivery at our hospital it seems to be an equal mix between mothers who abuse crack, heroin, binge drink or meth and those who have remained clean. I would expect that our infant mortality would be much more normal when controlled for such factors. Will it be normal, i have no idea, but I bet it will be closer to normal.

As to the whole argument about canadian per capita spending being vastly lower, there are a few reasons for this:

1) Healthier population
2) Waste in our system (yeah I said it)
3) Higher drug costs in US(we carry the burden of R&D for the world)
4) More technology in US
5) defensive medicine in US
6) the ease and speed of obtaining care of a specialist

The US does 3x more MRIs per capita and 2x more CTs per capita. Since a CT costs a few grand and an MRI costs much more, this accounts for some of the difference.

From one article in 2007: Average wait time to get an MRI in canada 10.3 weeks.
Average of 5 weeks to see an oncologist. I dont know about you but that cannot be good for outcomes.
Average wait time for an orthopedic surgeon >40 months!

From one article in 2007: Average wait time to get an MRI in canada 10.3 weeks.
Average of 5 weeks to see an oncologist. I dont know about you but that cannot be good for outcomes.
Average wait time for an orthopedic surgeon >40 months!

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Alright, do you have a link? If not, then whatever. I have personally met dozens of Canadians who live in the US. Guess how many prefer the American healthcare system over their native one? Not a single one. I don't care that it's anecdotal, it is very easy to understand:

It's because they don't have to worry about covering hospital bills while they're trying to recover from bypass surgery. And it's because in Canada you don't have a million people filing bankruptcy each year due to medical bills. I could go on but you get the point.

Yes, and yes.
Like I said, we have to strike a balance, and this is my idea for doing it. This country was built on compromise, and it's worked out pretty well so far.

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Welp, all of our differences come down to this point. You are willing to take taxpayer money and give it to private corporations to insure healthy patients with an ass-backwards billing system, I am not. I am sick and tired of for-profit corporations enriching themselves while 50 million people in this country go without health insurance. I am sick and tired of Aetna's CEO taking him $20 million per year just because he figured out how to **** up the billing process so much that some doctors just start writing off vaccinations or billing altogether. **** that, I am sick of taxpayer handouts.

Look, I know it's hard to swallow that our entire system is broken and needs to be thrown out. I understand that it goes against everything you've been told for the past two decades by Reagan, Bush, Clinton, W, the GOP and the democrats, but it is blindingly obvious.

All of the politicians, save for maybe a dozen, are LYING to all of you. Right now Obama has a healthcare "reform" group going that is only interested in postponing the inevitable collapse of our entire system. Obama has sold out just like the rest of the ****ing politicians in DC (Baucus, Kennedy, the entirety of the GOP). We are not going to see any reform, we are going to see more taxpayer subsidies for the insurance industry. ****

And the only reason is that if we did what we should do it would sink the stock market further since no one would want to own insurance company stock once people realized that they are utter failures and are going to be replaced.

One month I was in medical school, my resident took 2 afternoons off work. One day he went to get a CT scan done, and the other day an MRI done. For what? Common migraine headaches. Of course they found absolutely nothing. Of course, it was also a dick move to leave 1 medical student alone to run the entire consult service, but that's beside the point. This was not some boob who was insisting on this, but a doctor being treated at an academic institution no less. It was like this:

An MRI is what, $2000? Our society doesn't produce enough economic surplus for everyone to go get MRI's done. That would be 5% of GDP, if everyone was getting an MRI done each year!

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I agree with your comments, but isn't the threat of litigation a big factor? Doctors are doing unnecessary tests because they are afraid of missing something and trying to cover their rear. Am I wrong?

There are some fundamental issues that no one has really addressed yet.

First, everyone agrees that US health care is in serious trouble. However, an equitable, sustainable solution will require a complete revamp and restructure of the system. A patchwork, piecemeal fix-it job will only compound the problem

Second, the fundamental issue is the difference between conservatism and liberalism. Lets assume the following system:

1. Tort reform-Docs are immune to civil lawsuits. Malpractice is regulated by medical boards who have the power to fine and revoke medical licences.

2. Uncoupling of Tax exempt employer provided health care-people are responsible for purchasing (tax-deductible) their own high premium/low-deductable insurance policies, and deposit (tax-free) into health care savings accounts. Primary and preventative care is purchased by the individual (market forces are now able to drive down prices), and major procedures are paid for by insurance.

3. Certain "required" procedures are covered for everyone. These include cancer treatments, congenital defects, basically cost prohibitive procedures that have a high rate of success in prolonging life. These procedures would not include hip replacements for 80 year olds, procedures that might extend the life of a 90 year old person 6 more months, wasteful procedures essentially.

4. Extend retirement age. If people are living to 80 years, then extend the retirement age to 70+. Especially if they are drawing government health coverage.

A system like this would have numerous benefits. Market forces would force prices down. Vast majority would have access (by access, i mean that it is affordable) to health care. Would not encourage notion of entitlement. Would reinforce principles of self-sufficiency, etc.

The downside is that some people are going to be "shafted". People who don't purchase insurance, or don't put money into savings accounts, or generally live poor lifstyles, will get sick, not be able to afford care, and suffer from that situation.

Old people, will not have endless access to health care anymore. Feeding tubes, respirators, hip replacements, transplants, procedures that have little indication of extending life beyond a few years, won't occur anymore. In short, old people will die when they get really sick.

This strips it down to the difference between Conservatism and Liberalism.

Conservatism: Make these services available to everyone that is willing to do what it takes to obtain them. This means that some people will choose to not pay for health care, some will choose to not save their money. Some will get sick and not have the means to take care of it. If we try to base our society on principles of hard work and self sufficiency, then those who do not subscribe to such principles will fall behind. The main benefit is that the program is sustainable in the long term.

Liberalism: The government ensures that everyone is provided for. Everyone gets healthcare. The downside is that future generations will have no incentive to improve themselves because they are ensured a comfortable position. The extreme downside is that it has never been sustainable in the long term.

Alright, do you have a link? If not, then whatever. I have personally met dozens of Canadians who live in the US. Guess how many prefer the American healthcare system over their native one? Not a single one. I don't care that it's anecdotal, it is very easy to understand:[/b]

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I think it's pretty funny you demand a source in the first sentence, and then dismiss your own lack of evidence. Very clever.

It's because they don't have to worry about covering hospital bills while they're trying to recover from bypass surgery.And it's because in Canada you don't have a million people filing bankruptcy each year due to medical bills. I could go on but you get the point.[/b]

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Again, nobody thinks this is fair either. I propose stricter regulations on what insurance companies cover, and more transparency in the system in general. See my previous post with a link which explains why your bankruptcy claim is kind of far fetched.

Welp, all of our differences come down to this point. You are willing to take taxpayer money and give it to private corporations to insure healthy patients with an ass-backwards billing system, I am not. I am sick and tired of for-profit corporations enriching themselves while 50 million people in this country go without health insurance. I am sick and tired of Aetna's CEO taking him $20 million per year just because he figured out how to **** up the billing process so much that some doctors just start writing off vaccinations or billing altogether. **** that, I am sick of taxpayer handouts.

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You are misquoting me; I favor subsidizing the care for many of the "uninsurables" to make our current system more available for their needs. Also, if you think corporations have any less capacity for evil or than our government does; you are gravely mistaken. I have no idea what to make of your last statement because you seem to be in favor of tax dollars paying for every aspect of every citizen's healthcare- I am not.

Conservatism downside: Millions go without healthcare. System "sustainable" because we let hobos (read: military vets) die in the streets.

Hope this helps.

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Haha, that's great. Hey I'll play too!

Liberalism downside: System becomes "sustainable" by making sure no one assumes any responsibility for the wellbeing of themselves or their loved ones, because it's the Government's job! If I get diabetes and high Cholesterol from choosing KFC over Subway, it's ok because I can stand in line for Metformin and a Statin just like everybody else! Hooray!

Liberalism downside: System becomes "sustainable" by making sure no one assumes any responsibility for the wellbeing of themselves or their loved ones, because it's the Government's job!

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I find it scary that you can't seperate your political beliefs from discussions on health care delivery. Any system that is properly organized will deliver adequate healthcare to its citizens.
An adequate measure of how effective a particular health care system delivery is, is how it provides services to those who are the most disadvantaged.

I find it scary that you can't seperate your political beliefs from discussions on health care delivery. Any system that is properly organized will deliver adequate healthcare to its citizens.
An adequate measure of how effective a particular health care system delivery is, is how it provides services to those who are the most disadvantaged.

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Welcome back Medis.
I was being cynical b/c I thought his "Conservatism downside" response was kind of childish. For an actual argument, I would point to our VA system; they take care of many veterans.

I do not seperate my political and professional beliefs. I make no apologies for having the same set of morals for how I think about ethical issues, government, healthcare, business, etc etc. I am the same person at home, in Church, in school, and at work. I always find it odd when people say doctors have different "ethics" from the rest of society.

Liberalism downside: System becomes "sustainable" by making sure no one assumes any responsibility for the wellbeing of themselves or their loved ones, because it's the Government's job! If I get diabetes and high Cholesterol from choosing KFC over Subway, it's ok because I can stand in line for Metformin and a Statin just like everybody else! Hooray!

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I've heard this argument frequently on SDN. No American has been able to explain why most of us from single-payer countries are healthier than Americans. I mean, considering how we don't have to pay for our health care, why don't we sit around all day eating deep-fried Mars Bars?

Alright, do you have a link? If not, then whatever. I have personally met dozens of Canadians who live in the US. Guess how many prefer the American healthcare system over their native one? Not a single one. I don't care that it's anecdotal, it is very easy to understand:

It's because they don't have to worry about covering hospital bills while they're trying to recover from bypass surgery. And it's because in Canada you don't have a million people filing bankruptcy each year due to medical bills. I could go on but you get the point.

Welp, all of our differences come down to this point. You are willing to take taxpayer money and give it to private corporations to insure healthy patients with an ass-backwards billing system, I am not. I am sick and tired of for-profit corporations enriching themselves while 50 million people in this country go without health insurance. I am sick and tired of Aetna's CEO taking him $20 million per year just because he figured out how to **** up the billing process so much that some doctors just start writing off vaccinations or billing altogether. **** that, I am sick of taxpayer handouts.

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I'm a med student rotating in the metro Detroit area and I have seen numerous Canadians cross the border and pay cash to get timely healthcare.
Here's a link about the wait time for MRIs, etc, and a few highlights from the article.

A typical Canadian seeking surgical or other therapeutic treatment had to wait 18.3 weeks in 2007, an all-time high, according to new research published Monday by independent research organization the Fraser Institute.

"Despite government promises and the billions of dollars funnelled into the Canadian health-care system, the average patient waited more than 18 weeks in 2007 between seeing their family doctor and receiving the surgery or treatment they required," said Nadeem Esmail, director of Health System Performance Studies at the Fraser Institute and co-author of the 17th annual edition of Waiting Your Turn: Hospital Waiting Lists in Canada.

Ontario recorded the shortest waiting time overall (the wait between visiting a general practitioner and receiving treatment) at 15.0 weeks, followed by British Columbia (19.0 weeks) and Quebec (19.4 weeks). Saskatchewan (27.2 weeks), New Brunswick (25.2 weeks) and Nova Scotia (24.8 weeks) recorded the longest waits in Canada.

The median wait for an MRI across Canada was 10.1 weeks. Patients in Ontario experienced the shortest wait for an MRI (7.8 weeks), while Newfoundland and Labrador residents waited longest (20.0 weeks).

"So, let's take a look at a rough breakout of the 47 million statistics. First, 12.7 million (27%) of the 47 million are uninsured for only a part of the year in which they are counted, and are, therefore, ultimately insured. This is an issue of portability of health insurance. Second, around 10.34 million (22%) of the 47 million are listed as "not American citizens''. Surely the solution for this group has more to do with immigration reform than reform of the health-care system? Third, 19% constitute a group of roughly 9 million people, half of whom earn $50&#8211;75,000 a year while the other half earn more than $75,000 a year. Many of these individuals are healthy young people who can afford insurance but choose not to buy it. Fourth, a group of about 8 million people (17% of the 47 million) are actually eligible for health insurance under a variety of existing plans but don't take advantage of them, sometimes owing to ignorance. The lack of insurance in this group is surely a problem of patient education. Finally, 15% make up a fifth group of approximately 7 million people who might actually represent the true "uninsured'' or those&#8216;&#8216;without insurance whatsoever''. This situation is certainly a tragedy for a country as rich as the US. When the 47 million uninsured figure, is quoted it implies that all of these individuals represent the fifth group of uninsured individuals, which seems incorrect. It also implies that fixing the problem of the uninsured will fix the problem of access to care when, in reality, they are two separate issues."

I've heard this argument frequently on SDN. No American has been able to explain why most of us from single-payer countries are healthier than Americans. I mean, considering how we don't have to pay for our health care, why don't we sit around all day eating deep-fried Mars Bars?

Motivations for staying healthy are non-monetary.

Edited to add: Brits don't pay for drugs, but we do.

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I was making a cynical comment in response to the "Conservatism downside" post seen earlier.

I'll reverse the argument and ask how you think the health crisis of preventable disease we have in this country will be affected switching to a single-payer system.

I've heard this argument frequently on SDN. No American has been able to explain why most of us from single-payer countries are healthier than Americans. I mean, considering how we don't have to pay for our health care, why don't we sit around all day eating deep-fried Mars Bars?

Motivations for staying healthy are non-monetary.

Edited to add: Brits don't pay for drugs, but we do.

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You answered your own question. Are americans less healthy because they don't have access to healthcare or because their lifestyle is much less healthy?

Also, the population of the US is much different than those of other countries. Just a question, do other countries have the massive babyboomer population that we do? It could be possible that correcting for that additional baby-boomer poplation would show that the US is not much less healthier than the rest of the developed world.

Bottom line, correlation is not causation.

You also cite Britain's system. Britain is near bankruptcy because of their system. Is the only choice we have. Everyone gets substandard healthcare for a few generations until the country goes bankrupt?

You answered your own question. Are americans less healthy because they don't have access to healthcare or because their lifestyle is much less healthy?

Also, the population of the US is much different than those of other countries. Just a question, do other countries have the massive babyboomer population that we do? It could be possible that correcting for that additional baby-boomer poplation would show that the US is not much less healthier than the rest of the developed world.

Bottom line, correlation is not causation.

You also cite Britain's system. Britain is near bankruptcy because of their system. Is the only choice we have. Everyone gets substandard healthcare for a few generations until the country goes bankrupt?

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we interrupt your regularly scheduled brainwashing for this special announcement:

DING!DING!DING!DING! WE HAVE A WINNER.....

but that pointed fact does nothing to further the progressive cause, so we will ignore it, refute it, and deny that it exists so that we can create a gov't system that removes personal responsibility and "shares the wealth"... regardless of contribution....

I'll reverse the argument and ask how you think the health crisis of preventable disease we have in this country will be affected switching to a single-payer system.

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I doubt it would be affected at all because all our health care systems are "after the fact" and have little to do with prevention. That'd take a cultural change.

BTW, futuredr32 was quoting from the Fraser Institute, which is hardly an "independent research organization," but a right-wing think tank determined to dismantle our single-payer system so that huge profits can be reaped.

I mean, we've got 30 million people spread over five time zones. Some of our challenges related to health care delivery are geographical. I haven't totally vetted Wikipedia's entry for accuracy, but at least it's ideologically neutral.

You also cite Britain's system. Britain is near bankruptcy because of their system. Is the only choice we have. Everyone gets substandard healthcare for a few generations until the country goes bankrupt?

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The American health care system costs twice as much per capita as the Canadian one. My math tells me Americans will go bankrupt twice as fast as Canadians.

The American health care system costs twice as much per capita as the Canadian one. My math tells me Americans will go bankrupt twice as fast as Canadians.

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Well, I doubt that is true, they are the wealthiest country in the world. More likely they will continue to blindly throw money at it in an effort to stifle any special interest groups/politicians that actually want to change/reform any part of it.

The American health care system costs twice as much per capita as the Canadian one. My math tells me Americans will go bankrupt twice as fast as Canadians.

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Nobody who has actually studied the problem is going to say that our system is fine the way it is.

I support a system that makes healthcare accessible (not free) to everyone. However, this means that there will be people who will not take advantage of it. If we want to have a society that is based on hard work and self reliance then we have to accept that there will be people who do not work hard and refuse to be self reliant.